Telescopic catheter-in-long sheath and parallel to a stiff guide wire technique for complex pulmonary artery anatomy

Selective catheterization and procedures in pulmonary arteries may be very challenging. We developed a technique in which an extra-stiff guide wire was placed in a pulmonary artery. Across it a long sheath was placed proximally or controlateral to the lesion to be treated. An angiographic catheter was then placed parallel to the guide wire in a telescopic way within the long sheath. This system facilitated greater stability, allowing fine tuning of catheter position to reach and treat the target lesion. Here, we present five cases in whom this technique was used; a patient with multiple arteriovenous fistulas in a difficult to reach area and four subjects with complex pulmonary artery stenoses.